In the early 1970s, a young Canadian medical student touched down in war-torn Vietnam to get a first-hand look at the life-and-death heroics of U.S. MASH [mobile army surgical hospitals]units. Greg Powell locked those scenes in his memory, and 40 years later, he is the driving force behind Alberta’s Shock Trauma Air Rescue Society.

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Known as STARS, the emergency medical transport service is a medical innovator with a distinctive public-private funding model. From its Alberta base, it also serves eastern British Columbia, will soon operate in Saskatchewan and expects to expand to Manitoba, where it has been helping with the flood emergency. Dr. Powell sat down with his wife Linda, who handles governance issues and external relations, to explain what makes their $30-million “business” tick.

How did this get started?

Greg Powell: As a university student, I went to do an elective with the Australian flying doctor service. On the way there, a woman in the Canadian High Commission in Hong Kong said, ‘You should go to Vietnam.’ So I stopped there and I never regretted it. It was fascinating to see the reality of Vietnam. I found my way out to a MASH unit and worked with the surgeons for a couple of days, and I saw the helicopters coming in. They were saving lives. Going from the battlefield to sophisticated surgery in 20 minutes was amazing.

On the way out, I got into a rocket attack by the Viet Cong, and I almost got killed. I thought ‘I’m not really well trained for this.’ I left on the first plane to Phnom Penh.

How did that relate to Alberta?

Greg: It formed the idea. When I later became director of emergency medicine at Foothills Hospital in Calgary, I saw a lot of incoming people who could have been easily saved if time were on our side.’ [At that point, Alberta had a 50 per cent higher trauma death rate than other Canadian centres.]/p>

A young woman with a perfectly normal pregnancy came in from Eastern Alberta, and she died just before she got through the door because of a stuck placenta. There were the husband and the baby but no mom, and I thought, ‘This is crazy – we can fix it.

A couple of guys and I went $250,000 in debt to start this service. The first mission was in September, 1985, and we rented time on helicopters. [Now Stars has its own fleet of bright red choppers.]/p>

Were you both working in STARS then?

Linda Powell: Greg and I had met at McGill University in Montreal; I’m a Quebecker, had gone to McGill and worked at Royal Vic Hospital. I got involved in the business in 1991 while raising our three little kids. I went back to work as a physiotherapist part time but was on the phone at STARS the rest of the time. It continued from there.

What were the pivotal events?

Greg: At Calgary’s Winter Olympics in 1988, somebody said, ‘Geez, we need helicopters’ and so suddenly our helicopters started making appearances at Olympic venues. People said ‘Who was that?’ But we were still struggling. We were getting paid by government per mission at a fairly low rate and it was nowhere near recovering our costs. Money was coming in through bake sales and passing the hat at the back of the helicopter.

Then someone from the town of Hanna suggested we should go out there one Friday night. There was a banner above the door of the little community hall that said, ‘Hanna Helping STARS.” They had 400 people crammed in there, with the lady’s auxiliary doing the supper and there were auctions.

At the end of the evening, they called me up to say a few words and they gave me a standing ovation before I even spoke. That’s when my life really changed. There was a powerful reason to want this program to exist. And they gave me a cheque for $100,000. One little town, one evening.

Linda: Then this grassroots effort caught a bit of prairie fire in other communities. It’s about that sense of helping these places.

How do you raise money?

Greg: We get about 25 per cent from government and the rest from community partnerships and fundraising – from selling calendars to money-raising trail rides to corporate donations [including many energy companies] A big chunk comes from our lottery, but that’s been more recent.

The relationship with government has been variable. A lot of civil servants were constantly trying to take us over or make us part of the larger health care system. But we see STARS as a bolt-on and we’re the only ones with the wrench. We can get tighter or back off a bit. People have to see us as an independent decision-making entity that can alter the course of patient care – or why should they give us money? We are a part of the health care system in a unique way that is appreciated by many at the upper political level, but very unappreciated by civil servants.

As a mobile medical service, how do you fit into a Canadian model with its barriers to professionals working across provincial borders?

Greg: For governments, it’s all about who’s going to pay the licensing fees and such. I say. ‘Come on guys, get beyond that conversation and talk about what we can do [for the patient]’ If we could do something good for Canadian medicine here, it would be a really neat thing, because it’s been frustrating over the years to see these silly barriers.

Linda: The timing is good because of the Trade, Investment and Labour Mobility Agreement, first negotiated between B.C. and Alberta, and now the New West accord with Saskatchewan coming in. There is a conversation going on [about reducing provincial hurdles]

Does your fundraising success stem from being part of the safety lifeline in rural Alberta’s energy and farm fields?

Linda: When you go to a corporate event or a safety briefing, people are profoundly passionate about it – they are protecting their families. I remember a community ride involving a family who had lost a son. A reporter asked me if I was thankful to the community for helping [STARS] But the mother spoke up: ‘No, no, no. We are doing this to help ourselves. It is important to us.’

Greg: A farmer came up at the end of the meeting in Hanna, and told me, ‘Out here, when you had “the big one,” you used to die. Now that you’re here, we have a chance.’

What makes it distinct from other programs?

Greg: We’ve had the wonderful opportunity to do things for the right reasons, being able to apply safety measures that are not eclipsed by shareholder value or other economic drivers. There is our hybrid model of funding, plus a focus on patient care that we resolutely stick by.

More broadly, this is cost avoidance. If you save a stroke from being completed – saving someone from being a hemiplegic the rest of their life – it probably costs $5,000-$10,000 up front, but you save $2-million downstream in health costs. The silos of cost accounting in the government don’t connect that. We have to get that dialogue going.

What keeps you awake at night?

Greg: We live in a high risk, high-consequence environment all the time. Our people live a bit on the edge and now we’re expanding. I have to make sure we keep the eye on the ball in terms of execution.

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